Provider Demographics
NPI:1134605959
Name:JIMENEZ, ASHTON FISHER (MS, LPC-S)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:FISHER
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:MS, LPC-S
Other - Prefix:
Other - First Name:ASHTON
Other - Middle Name:ELISABETH
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:512 W MLK JR BLVD # 148
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1231
Mailing Address - Country:US
Mailing Address - Phone:512-686-6012
Mailing Address - Fax:512-842-7227
Practice Address - Street 1:7111 BOSQUE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-4070
Practice Address - Country:US
Practice Address - Phone:512-686-6012
Practice Address - Fax:512-686-6012
Is Sole Proprietor?:No
Enumeration Date:2018-07-15
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66488101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional